Healthcare Forensics Analyst: Payment Integrity & Audits

BDO; Las Vegas (NV); On-site; USD 65,000 - 85,000; Full time

Job summary

BDO is seeking an Experienced Associate in Healthcare Forensics to identify, analyze, and resolve payment inaccuracies across healthcare claims related to reimbursement disputes, fraud, waste, and abuse investigations. The role demands strong data analytics, regulatory awareness, and the ability to deliver high-quality client work.

The position requires at least 3 years in healthcare consulting or related fields with familiarity in Medicare, Medicaid, and commercial reimbursement, coding, and

Qualifications

• Requires 3 years of healthcare consulting, revenue cycle, claims auditing, or payment integrity experience.
• Experience with Medicare, Medicaid, and Commercial reimbursement preferred.
• Strong understanding of payer policies, contracts, and regulatory guidelines.

Responsibilities

• Provides investigation and analysis to a variety of clients, including outside counsel, regulators, and companies involved in litigation, investigation, dispute, regulatory, and compliance matters.
• Contributes to forensic engagements related to medical coding and billing, revenue cycle, payment integrity, the False Claims Act, the Stark Law, the Anti-Kickback Statute, and other matters.
• Analyzes healthcare claims data to identify improper payments, billing errors, and potential fraud, waste, or abuse.
• Develops and implements strategies to improve payment accuracy and mitigate overpayments.
• Collaborates with cross-functional teams to validate findings and recommend corrective actions.
• Interprets payer policies, provider contracts, and regulatory guidelines to assess claim appropriateness.
• Prepares and presents detailed reports and recommendations to clients and internal stakeholders.
• Supports the design and enhancement of payment integrity tools, algorithms, and audit methodologies.
• Stays current on industry trends, CMS regulations, and emerging payment models.
• Develops working relationships with internal and external stakeholders and communicates effectively.
• Assists with the preparation of high-quality deliverables to ensure client satisfaction.
• Acts with professionalism and integrity when working with confidential and sensitive information.

Skills

Communication skills

Project management

Analytical thinking

Problem solving

Multitasking

Attention to detail

Education

Bachelor’s degree in Healthcare Administration, Public Health, or Business

High School Diploma or equivalent

Active credential in healthcare coding or CHC

Tools

Excel

SQL

SAS

Tableau

EPIC

Cerner

Athena

Coding/DRG software

Job description

BDO is seeking an Experienced Associate in Healthcare Forensics to identify, analyze, and resolve payment inaccuracies across healthcare claims related to reimbursement disputes, fraud, waste, and abuse investigations. The role demands strong data analytics, regulatory awareness, and the ability to deliver high-quality client work.

The position requires at least 3 years in healthcare consulting or related fields with familiarity in Medicare, Medicaid, and commercial reimbursement, coding, and